Manejo das disfunções sexuais em mulheres com vulnerabilidade emocional: gravidez, pós-parto e depressão

Abstract

Introduction: Female sexual dysfunction is a multifactorial condition influenced by physiological, psychological, hormonal, and social aspects, significantly affecting women's quality of life. Pregnancy, postpartum, and the use of antidepressants are risk factors for sexual dysfunction. Objectives: To evaluate the efficacy of pharmacological and non-pharmacological therapies for treating female sexual dysfunction during pregnancy, postpartum, and antidepressant use. Methods: Three systematic reviews and meta-analyses were conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, exclusively including randomized clinical trials (RCTs). Searches were performed in PubMed, Scopus, Web of Science, Embase, PsycINFO, PEDro, Cochrane Central, and ClinicalTrials.gov databases. The risk of bias was assessed using the Risk of Bias 2 (RoB 2) tool, and the certainty of the evidence was classified according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. The meta-analysis was conducted using continuous data and mean difference, applying the inverse variance method for study weighting. Heterogeneity among the studies was assessed using the I² test. The fixed-effect model was adopted when I² ≤ 50%, while the random-effects model was applied for I² > 50%. A 95% confidence interval was calculated for the estimates. Additionally, sensitivity analyses were performed to assess the robustness of the results. Results: For sexual dysfunction during pregnancy, 24 studies (1,557 participants) were included, with nine selected for meta-analysis. Cognitive-Behavioral Therapy (CBT) increased Female Sexual Function Index (FSFI) scores by 6.82 points (95% CI: 1.63– 12.01, p=0.010, I²=73%). The PLISSIT model (Permission, Limited Information, Specific Suggestions, and Intensive Therapy) increased FSFI scores by 6.07 points (95% CI: 3.80–8.35, p=0.00001, I²=80%), and sexual education interventions led to an increase of 5.82 points (95% CI: 4.19–7.46, p=0.00001, I²=81%). The certainty of the evidence was high for CBT and PLISSIT and low for sexual education. For postpartum sexual dysfunction, 22 studies were included, of which eight (634 participants) were analyzed in the meta-analysis. The analyzed interventions were the PLISSIT model (increase of 5.82 points in FSFI, 95% CI: 1.27–1.84, I²=0%), pelvic floor exercises (increase of 4.27 points in FSFI, 95% CI: 1.23–7.32, I²=99%), and Kegel exercises (increase of 41.54 points in FSFI, 95% CI: 33.27–49.80, I²=99%). The certainty of the evidence was classified as very low for all interventions. For antidepressant-induced sexual dysfunction (AISD), 11 RCTs (859 participants) evaluating different pharmacological treatments were included. Bupropion SR 150 mg/b.i.d. increased the sexual desire subdomain score by 1.74 (95% CI: 1.03–2.44, p=0.00001), arousal by 1.30 points (95% CI: 1.16–1.43, p=0.00001), and orgasm by 1.90 points (95% CI: 1.78–2.02, p=0.00001). Regarding depressive symptoms, there was an increase of 0.46 points (95% CI: -0.71–1.63, p=0.44). The certainty of the evidence was considered low. Conclusions: Non-pharmacological interventions, such as CBT, the PLISSIT model, and sexual education, were effective in treating female sexual dysfunction during pregnancy. In the postpartum period, no intervention showed a superior effect compared to placebo. For AISD, bupropion SR 150 mg/b.i.d. demonstrated therapeutic potential for improving sexual function but not for depressive symptoms.